Surgical management of branch renal artery disease. Value of in situ and extracorporeal technique.

Vascular reconstruction of the kidney is technically difficult in patients with branch renal artery disease. Formerly, many patients in this category were considered either inoperable or candidates for total or partial nephrectomy. However, advances in vascular reconstructive techniques during the past decade have improved this outlook and successful revascularization is now possible in most cases. This evolution has been primarily due to the incorporation of microvascular and extracorporeal techniques into the armamentarium of the renovascular surgeon. These techniques, their respective indications, and the merits of in situ versus extracorporeal repair are reviewed herein.